[Systemic lupus erythematosus : Unusual cutaneous manifestations]

Area of Science:

• Dermatology and Rheumatology
• Immunology
• Infectious Diseases

Background:

• Systemic lupus erythematosus (SLE) is frequently associated with mucocutaneous manifestations, affecting up to 80% of patients.
• While specific criteria exist, many unspecific yet indicative skin and mucous membrane symptoms occur in SLE.
• These include conditions beyond the classic butterfly rash, chronic cutaneous lupus, oral ulcers, and photosensitivity.

Observation:

• This study investigated less common mucocutaneous signs in SLE patients.
• Methods involved a literature review and analysis of patient medical histories, presenting rare disease courses.
• Specific observations included periungual erythema, telangiectasias, splinter hemorrhages, hand papules, scaling erythema with necrosis, and antiphospholipid syndrome-related necroses.

Findings:

• Unspecific but typical mucocutaneous signs in SLE patients were identified.
• These included periungual changes, hand lesions, ear necrosis (especially with complement deficiency), and antiphospholipid syndrome necroses.
• The study also highlighted features of neutrophilic urticarial dermatosis, bullous SLE, and severe bacterial sepsis caused by Neisseria flavescens/macacae in immunosuppressed individuals.

Implications:

• The identified mucocutaneous symptoms can serve as early indicators for SLE diagnosis.
• Prompt recognition of these signs may lead to earlier intervention and improved patient outcomes.
• The study underscores the risk of severe infections from typically non-pathogenic bacteria in immunocompromised SLE patients, emphasizing the need for vigilance.